Why We Have Too Many Medical Specialists: Our System’s An Uncoordinated Mess

‘Surplus’ of medical specialists in Canada no surprise

Morris-Barer

It is difficult to imagine the recommendations that might emerge from such a meeting being worse than the current uncoordinated mess. At present, policy decisions, or often the lack thereof, are failing to meet the needs of new trainees or of patients. For example, there are no national (and few provincial) mechanisms in place to channel new graduates into the specialties where they are likely to be most needed rather than into the specialties most needed by teaching hospitals or most favoured by students. And despite the fact that we live in a hyper-active era of tweets and blogs in which the new generation seems to be constantly connected, there is no structured electronic meeting place for job hunters and job seekers. New graduates are somehow failing to figure out where the jobs are (and there are, in fact, plenty of communities desperately seeking specialists). In some cases, at least, the new specialists are simply the victims of the completely predictable fallout from that earlier medical school expansion. When those ministers of health agreed to fund an approximate doubling of medical school places, what did they think would happen when those students started graduating? Was there a plan in place to ensure that the complementary resources that are required for their practices would also be funded and in place? In a word, no. For example, operating room capacity or at least working capacity, meaning an available operating suite plus the funds, supplies and complementary staff to operate it has not kept pace. To make matters worse, the capacity is not used efficiently, and some of those who control that capacity are not all that keen to share with their younger brethren. The consequences in our future many more new physicians looking for practice opportunities each year, than old physicians retiring are as predictable as what we are seeing in the Royal College findings today.

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The result was an almost doubling of first-year entry numbers, from about 1,575, to around 3,000 per year. Once you consider this fact, the startle factor disappears. Canada now has at least 85 per cent more new physicians ready to enter practice each year, on average, than physicians retiring. And this is before considering those Canadians who have gone to medical schools abroad and then returned hoping to practice in Canada, or the influx of medical graduates from other countries. Their numbers have also increased dramatically over the past decade, and there is considerable pressure, particularly from Canadians who have gone abroad for training (currently about 3,500, with more joining every year) and organizations representing them, to increase numbers even further. It is not that the one in six implies that Canada now has an overall surplus of specialists, any more than the widespread claims of shortage in the mid-1990s meant we then had an overall shortage of physicians. Both then, and now, we have, rather, an inability or unwillingness as a country to develop plans and policies designed to train and deploy physicians in a sensible manner. The report was, however, correct in noting that there is no quick fix here. The Royal Colleges plan to convene a meeting early next year to discuss a nationally coordinated approach to health system workforce planning may be a useful start. It is difficult to imagine the recommendations that might emerge from such a meeting being worse than the current uncoordinated mess. At present, policy decisions, or often the lack thereof, are failing to meet the needs of new trainees or of patients. For example, there are no national (and few provincial) mechanisms in place to channel new graduates into the specialties where they are likely to be most needed rather than into the specialties most needed by teaching hospitals or most favoured by students. And despite the fact that we live in a hyper-active era of tweets and blogs in which the new generation seems to be constantly connected, there is no structured electronic meeting place for job hunters and job seekers. New graduates are somehow failing to figure out where the jobs are (and there are, in fact, plenty of communities desperately seeking specialists). In some cases, at least, the new specialists are simply the victims of the completely predictable fallout from that earlier medical school expansion. When those Ministers of Health agreed to fund an approximate doubling of medical school places, what did they think would happen when those students started graduating?

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